4 ATLANTIC ST -BPA-13-668 REMOVE & INSTALL NEW FURNACE z
Commonwealth of Nlassachtisetts
Sheet lNletal Permit
Date: 61
listim:rtcd Job Cost: S _�—K Permit Fee: S 6
Plans Submitted: YES _ NO -Z Plans RCViC%VCd: YES NO
Business License d _ Applicant License # 7
Business Intimnation: Property Owner/Job Location Information:
Name: PAOt4E M60APiNtcig' Name: 1l�u Lt iiFlNl
Street: 'y 06-0 O, -Ld eajo P� ( Street:
City/'Town: J 0(950 City/Town: rA E a�
'Telephone: R��l'Z��' al 1 Telephone: �) ' let L{ ' 7 7
Photo I.D. re r /_CpsofPhoto I.D. attached:
YES_ NO y
swrnwar
J-I /•M-I-unrestric�Jicense�
J-2 / :M-2-restricled to dwellings 3-stories or less and commercial up to 10,000 sq. 11. / 2-stories or less
Residential: 1-2ramily_z Multi-t'amily_ Condo/ "Townhouses Other_
Commercial: Office_ Retail _ industrial _ Educational
Institutional_ Other_
Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. _ Number of Stories:
Shect metal work to be completed: New Work: -.,/ Renovation:
I IVAC _Z Metal Watershed Roofing_ Kitchen E.ehauat System
`fetal Chimney/ Vents_ Air Balancing
Pr(o%ide detailed description or work to be done:
� �Qh�e,(� t�
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes E] No ❑
If you have checked Yes, indicate the Other pe of coverage by checking the appropriate box below:
A liability Insurance policy� type of indemnity ❑ Bond El
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent Cl
Signature of Owner or Owner's Agent
By checking this box ,I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit issued for this application will be
In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to Insulation Installation: YES_NO
Pr o rress Inspections
L D
Date Comments
Final Inspection
Data Comments
Type License:
By Master
nue ._ ❑ Master-Restricted
❑Journeyperson Signature of Licensee
Permit x ._—.--- ❑Journeyperson-Restricted 0 6 2
License Number:
Fez S .._ - ❑----- — —
------------ Check al'+r.v^rnt.c;s.JOY
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Inspector Sigma ure f Pc 44proval